1473THE NATIONAL INSURANCE ACT.

was the crucial decision of the whole meeting, was about tobe put to the vote, a card vote was demanded. The amend-ment was opposed by Dr. W. DUNCAN and Dr. E. J. MACLEAN,who urged the meeting not to take up a position which wouldprobably bar the way to further negotiations.The result of the card vote was announced on Wednesday

morning. Constituencies representing 9292 votes were infavour of the amendment, and those representing 9269 wereagainst. In view of the serious position revealed by thisvote the meeting was addressed by the chairman, Mr.VERRALL, and the deputy chairman, Mr. E. B. TURNER, whoappealed for some compromise which would secure unitedaction and avoid a deadlock. To this end it was agreed thatan effort should be made to frame a comprehensiveamendment.Mr. D. F. ToDD proposed, and Dr. H. HOYLE WHAITE

seconded. an amendment of which the first part ran as

follows :-That this Representative Meeting instructs the Council to forward to

the Chancellor of the Exchequer a copy of the resolution passedyesterday by an overwhelming majority, and to draw his attention tothe points on which it would be possible for a conference between him-self and representatives of the Association to take place; and that thismeeting do now proceed to draw up what it believes to be the reason-able demands of the profession to be laid before the Chancellor by acommittee to be elected for the purpose.

This was carried unanimously amidst applause, and themeeting at once proceeded to arrange the constitution andmethod of election of the committee.

It was decided that the deputation to confer if necessarywith the Chancellor of the Exchequer in accordance withthe above resolution should consist of Mr. T. J. Verrall

(chairman of Representative meetings), Dr. J. A. Macdonald(chairman of Council), Mr. E. B. Turner (deputy chairmanof Representative meetings), Dr. R. M. Beaton (London), andDr. T. A. Helme (Manchester) ; and that a new State Sick-ness Insurance Committee should be elected in the samemanner as the last Committee.The second part of the resolution was passed in the

following amended form :-The State Sickness Insurance Committee which will be elected shall

be entrusted with the duty of arranging the conference, and shallreceive the report of the Special Committee appointed to interview theChancellor of the Exchequer. On receiving the report of the Com-mittee on the interview with the Chancellor the State Sickness Insur-ance Committee will report to the Council the result of the conference.Should there be any modification of the conditions now offered, theCouncil will thereupon report the whole matter to the Divisions in theUnited Kingdom, who will be requested to call meetings of all membersof the profession resident in the Divisional areas to vote as to whetherthe final terms suggested should be accepted or not. The votes of allpresent and voting to be recorded in two classes-those of members ofthe Association and non-members respectively-and the combinedrecord of all such votes of members of the Association for or againstacceptance be decisive, the vote given by non-members to be recordedfor the general information of the Association.

Following the mid-day adjournment the RepresentativeMeeting proceeded to consider in detail the instructionsunder which the Special Committee of five and the StateSickness Insurance Committee should act. This includedthe formulation and arrangement of the " reasonabledemands" mentioned in the first part of Mr. Todd’sresolution.The meeting spent many hours in discussing the points

which should be brought before the Chancellor of the

Exchequer at the proposed conference. When this importantbusiness had been disposed of a motion standing in the nameof Birmingham Central was proposed by Dr. HOYLE WHAITEas follows:That until some general scheme of contract or other form of medical’

service is approved by the Association, the members of the BritishMedical Association decline, after Jan. 15th, 1913, to undertake or con-duct any form of contract practice for non-insured persons, exceptupon such terms as shall be approved by the Council of the Association

This was opposed by Mr. TODD on behalf of collierysurgeons; and Dr. MACDONALD suggested that the mattershould be held over for the present. The motion waseventually carried with the date changed to March 25th,1913.The remainder of the report of Council was then approved,

and the items of the agenda not dealt with were referred tothe Council. The meeting did not close until after midnight.

Professor Grafton Elliot Smith, F.R.S., hasbeen awarded a medal by the Royal Society for hisresearches on the comparative anatomy of the brain.

THE NATIONAL INSURANCE ACT.

THE SOCIETY OF APOTHECARIES, LONDON, AND THE ACT.THE following resolutions have been passed by the Parlia

mentary Committee of the Society of Apothecaries :—

1. That in the opinion of this Committee the conditions set up by’the Provisional Regulations of the Insurance Commissioners, datedOct. 1st, 1912, are of such a nature as to interfere injuriously withthe rights and proper independence of the medical profession and withefficiency in the treatment of insured persons.

2. That medical practitioners, in matters concerning their professionalconduct, ought not to be tried before a tribunal that is not professional,the decisions of which may have the most serious effect on theirreputation and practice.

3. Seeing that the carrying out of the Provisional Regulations 1&left largely in the hands of the Local Insurance Committees, it wouldbe unwise to agree to accept them (even if otherwise satisfactory) solong as the insured persons are represented upon these Committees byan overwhelming majority.

4. That attention should be called to the advisability of establishingtuberculosis centres in connexion with those hospitals to which medicalschools are attached.

5. That further efforts should be made to maintain the right of themedical practitioner to dispense his own medicines to insured personsunder the Act.

-

THE INSURANCE ACT AND HOSPITAL RESIDENTS.

Application having been made to the Insurance Com-missioners for the determination of the question whetherresident medical officers employed by hospital authorities to’render professional services in a hospital are required to beinsured under Part I. of the National Insurance Act, apublic hearing was held on Oct. 22nd, 1912, and the Com-missioners have given the following decision : ’’ That resi-dent medical officers at hospitals employed under theconditions referred to at the hearing on Oct. 22nd, 1912,are not employed under a contract of service within the-

meaning of the National Insurance Act, and are accordinglynot required to be insured thereunder, even if their rate ofremuneration does not exceed in value £160 a year."

THE IMPERIAL MEDICAL REFORM UNION.

We have received from Mr. George Brown, the general.secretary of this organisation, a statement for publication!explaining why the Executive Committee of the Union haveresolved to recommend the acceptance, given certain con-cessions, of the terms offered by the Government for the;medical attendance of insured persons :-"One of the chief objects," he writes, "of the Union is’to obtain

more satisfactory terms for club practice, preferably on the basis;of payment for work done.’ From the time that the Chancellorof the Exchequer introduced the Insurance Bill to the House ofCommons the Council of the Union have unceasingly endeavoured toobtain recognition of the principle of payment for work done. Whilstthe Bill was passing through its various (stages in the House of.Commons repeated representations were made to the Chancellor of theExchequer, the leaders on both sides of the House, English, Scotch,and Irish, were interviewed, and every Member of Parliament wasappealed to by letter to favourably consider the method proposedby the Union, viz., payment for services rendered and medicinessupplied....... Since the Bill became an Act of Parliament, recog-nising that the clauses relating to medical benefits’ were veryelastic, the Council of the Union have, through correspondence andinterviews, strongly urged upon the Commissioners the advisability ofrecognising the principle of payment for work done....... It was withgreat satisfaction that the members of our Council recognised whenthe Provisional Regulations were published that the Joint Committee,acting with the Insurance Commissioners for England, Scotland, andWales, had recommended provision to be made for ’ payment by attend-ance.’ As set forth under Section E, Part II., p. 28 of the ProvisionalRegulations (Wyman and Sons, Limited, Fetter-lane, E.C., price 2d.),the Local Health Committees are empowered to arrange with localdoctors willing to work under a scale of fees for the followingamong other services-viz., visits to patient’s residence, attend-ance at practitioner’s surgery, special day visits, night visits, andon Sundays, consultations with other doctors, operations, reduction offractures and dislocations, administration of anæsthetics, &c. Incountry districts doctors will be paid for supplying medicines, but intowns medicines will be supplied by chemists. The sum set apart forpayment of medical fees will be 8s. 6d. per head per annum wheremedicines are supplied by the doctor, and 7s. where these are suppliedby chemists. The experience of the National Deposit Friendly Society,with a membership numbering over 200,000, is that under the systemof payment by attendance a sum of 4s. per head per annum has beenmore than sufficient to pay the claims of the members for medicalattendance. Under the National Insurance scheme it is possiblethat the payments to doctors may exceed those hitherto paidby the National Deposit Friendly Society by at least 75 per cent.I would ask my professional brethren, therefore, whether theoffer of payment by attendance should not be accepted, subject tocertain concessions, such as the right to refuse one’s services under alower scale of fees than those usually expected from private patients.By accepting the offer we should strike a death blow to the objec-

t’onable capitation svstem. Should we reject the offer the alternatives,are a State Medical Service or the handing over of the sum set apart formedical remuneration to the Approved Societies, either of which would

1474 THE MONTESSORI SYSTEM OF EDUCATION.

It is to be feared, be ruinous to a large number of medical men who arenow doing good and successful work as general practitioners."

THE RESIGNATION OF SIR JOHN COLLIE FROM THEADVISORY COMMITTEE.

Sir John Collie has decided to resign his position as one ofthe Government nominees on the Advisory Committee of theNational Health Insurance Act. He writes to us as follows :

Up till now I had hoped and believed I might continue to be a realhelp to the profession by remaining at what I held to be a post of duty.when the ranks of the Committee were thinned by resignations.

I know (as only those on the Committee can know) that the laboursof the last few months have not been altogether in vain ; but, in viewof the decision of the Representative Meeting of the profession, I havenow handed in my resignation to the Chancellor of the Exchequer, forI feel that were I to continue on the Advisory Committee, I couldrender no further service to the medical profession, and my presenceon it would be open to misconstruction.

THE MONTESSORI SYSTEM OFEDUCATION.

MUCH enthusiasm has been displayed in educationalcircles with regard to the system of education of youngchildren, which of late years has been developed in Romeby the Dottoressa Maria Montessori, whose treatise on

the subject, translated by Miss Anne E. George, has

recently been published in England. 1 As the author isnot merely a teacher, but the first woman to receivethe degree of M.D. from the University of Rome, andher work bears the sub-title of "Scientific Pedagogy asApplied to Child Education," we think that a noticeof the methods of which she is the talented exponentmay be of interest to our readers. The occasion of a con-ference organised by the Child Study Society, London,jointly with the newly formed Montessori Society of theUnited Kingdom, preceded by a lecture by Madame Pujol-Segalas, of Paris, on the principles of the system, give anopportunity of reporting the opinions of some leadingeducationists on the subject. The attendance at thislecture on Nov. 15th was so large that it necessitated the

repetition of the lecture to a second audience, and onNov. 16th so numerous were those eager to take part in thediscussion that the chairman, Sir John A. Cockburn, M.D.,was obliged to limit each speaker to five minutes.The lecture was presided over by Mr. R. Blair, Education

Officer of the London County Council.Main Points of Montessori System.

Madame Puj ol-86-, alas’s chief points were the similarityof the basic principles of Froebel’s philosophy and thescientific experiments of Montessori-viz., the necessity totake nature as a guide " in endeavours to create conditionsfavourable to the child’s mental and physical development.She contended that while free play or spontaneous work ofthe faculties in the child had been admitted by Froebeliansas desirable, this object had rarely been obtained in practice.The pupil should not be made a slave to formal adult in-struction, which only caused a deformation of the naturalworking of the child’s mind ; but self-education, the kernelof the Montessori method, implied placing the child in themost favourable conditions to educate himself. To obtainsuccess a beginning must be made early, and the period fromthree to seven years of age is more or less decisive. Montessorischools are laboratories of experimental psychology in thetruest sense of the expression. The moral aspect of self-education from an early age in giving scope to self-control isan important feature. The Montessori "didactic material"saves energy on the part of pupil and teacher, and increasesthe creative and constructive faculty of the former byrendering classification easy. The sensorial exercises pre-sented to the pupil tend to productiveness gratifying to child-consciousness ; and learning to read and write follow thesenaturally through the aids the didactic apparatus affords.The master principle of the Montessori system is that of

self-development in a,n atmosphere of freedom, the onlylimit recognised being that no child in the exercise of hisown freedom shall interfere with that of others. It will be

1 The Montessori Method, by Maria Montessori. Translated from theItalian by Anna E. George, with an introduction by Professor H. W.Holmes, of Harvard University. London : William Heinemann. 1912.

understood that under such conditions the personality of theteacher counts for much. A demonstration of the "peda-gogical material " showed a variety of appliances, modelledto a great extent on those devised long ago by Seguin forthe sensorial training of imbeciles, including wooden blocksof various forms, cubes, cylinders, &c., and geometrical

insets which the child fits into appropriate cavities in simpleapparatus after the manner of a "puzzle." These educa.tional toys call into play the tactile and muscular senseand the pscyho-motor activities, and by an ingenious deviceof sand-paper letters in slight relief the child is led to appre-ciate (and ultimately, so to say, to absorb) through the

finger-tips alphabetical forms, both printed and script, so asto be able to reproduce them, thus teaching itself withouteffort the rudiments of reading and writing. Number is

taught objectively by a system of graduated and parti-coloured rods which the child arranges in the form of steps,thus attaining a notion not only of the value of figures but ofdimensions.

Nerves of rario1ls Speakers.At the conference successive speakers expressed very

varied views as to the relative value of Froebelian andMontessorian methods. Thus Miss E. E. Lawrence and MissMurray (representing Froebel Institutions) pointed out the

advantages their kindergarten children had not only fromreceiving sense impressions but from appeals to their reasoning-and imaginative powers, together with pleasing occupations," "which at once called into play the tactile and visual senses;whilst Montessorian advocates (including Miss Lidbetter andMr. Bertram Hawker) laid stress on the importance of lettingeach child work out its own educational salvation throughits individual spontaneous activity with as little guidance aspossible on the part of the teacher, whose function wasmainly to observe rather than to direct, except in the way offriendly advice. Dr. G. E. Shuttleworth referred to Séguin’ssystem of physiological education, which, as applied to thetraining of mentally deficient children on the lines laid downby him over 60 years ago-i. e., that "the physiologicaleducation of the senses must precede the psychical educationof the mind "-had produced admirable results, and seemedappropriate to the preliminary stages of normal infanteducation also, especially with the modified and improvedapparatus of the Montessorian system. Dr. Eric Pritchard

spoke of the importance of the teacher’s personality as anelement of success, which depended much on the power ofsuggestion in influencing the pupil rather than upon formsof apparatus merely or " systems " of instruction.The discussion served to show the growing interest in

physiological and psychological science which is graduallypermeating the minds of practical educationists, andmembers of the medical profession as well as teachers willfind profit if able to avail themselves of the meetings of theChild Study Society, the London section of which meetsfortnightly during the winter for the consideration of

subjects affecting child development at the Royal SanitaryInstitute premises, 90. Buckingham Palace-road, S. W.

PRESENTATIONS TO MEDICAL MEN.-At a com-plimentary reception given by the President and Council ofthe South Western Divisional Union of the Young Men’sChristian Association, Lord Kinnaird, on behalf of the

subscribers, presented Mr. C. A. Hingston, M.D. Lond.,of Plymouth, with an album as a slight expression of

gratitude for his invaluable work in the past 28 years as

president- of the South-Western District Union of the

Young Men’s Christian Association.-On Nov. 5th the

employees of the Torre and Torquay Railway Stationsof the Great Western Railway presented Mr. AlfredWightwick, M.B., Ch.B.Vict., with a silver-mountedwalking-stick, in appreciation of his services as honoraryinstructor of the St. John Ambulance Class at Torre.-At Yealmpton (Devon), Mr. William Southmead Lang-worthy, L.R.C.P. Lond., M.R.C.S. Eng., was presentedwith a silver spirit kettle, a walking-stick, and an

illuminated address as a mark of respect and esteem onthe occasion of his leaving Yealmpton after having

practised there for the past 17 years. Mrs. Langworthywas given a handbag. The members of the Rational Sickand Burial Association presented Mr. Langworthy with asmoker’s cabinet.